When Insurance Companies “Threaten Not to Pay,” What Should Policyholders Do: A Legal Perspective and Consumer Rights
👉 In practice, a significant number of consumers face problems when the time comes to claim compensation from insurance companies—whether involving motor vehicle accidents or health insurance claims. In some cases, insurance companies may resort to pressure tactics, delaying payments, or offering compensation lower than what the policyholder is legally entitled to receive. However, Thai law provides consumer protection mechanisms through insurance contract law and supervision by the Office of Insurance Commission (OIC). Policyholders can therefore exercise their legal rights to protect themselves.
📌 1. Claiming “Comparative Negligence” to Reduce Compensation
In motor vehicle accidents, insurance companies may suggest that the injured party accept “comparative negligence” and receive only partial compensation, such as half of the repair costs, alleging that taking legal action will take a long time.
However, determining negligence requires evidence such as dashcam footage, eyewitnesses, or police reports. The insurance company does not have the authority to unilaterally assign liability. If the injured party is in the right, they have the right to claim full compensation. Therefore, one should not sign to accept fault without verifying the facts. If the insurance company refuses to pay, you can request an official letter of denial to file a complaint with the OIC or proceed with a court lawsuit.
📌 2. Setting Loss of Use Compensation Lower Than Standard Rates
When a vehicle must enter repairs due to an accident, the injured party has the right to claim “loss of use compensation” from the fault party’s insurance. However, some companies may offer low rates, such as 200–300 Baht per day.
OIC guidelines establish approximate standards, such as personal passenger cars not exceeding 7 seats receiving around 500 Baht per day, and high-value vehicles receiving 700–1,000 Baht per day, depending on the vehicle type and actual repair duration. If the insurance company offers compensation lower than the standard, the injured party should gather communication records and garage documents to file a complaint with the OIC.
📌 3. Accusing Policyholders of “Concealing Pre-existing Conditions” to Void Health Insurance Contracts
In some cases, insurance companies may audit past medical histories and claim that the policyholder concealed a pre-existing condition in order to refuse compensation claims.
However, according to Section 865 of the Civil and Commercial Code, the insurance company must exercise the right to void the contract within the timeframe prescribed by law; otherwise, such right shall be extinguished. This principle aligns with the Incontestability Clause concept, which generally dictates that once an insurance contract has been in effect for approximately 1–2 years, the insurance company cannot cite information concealment to retroactively void the contract, unless there is clear fraud. If a claim is denied, policyholders can file a complaint with the OIC or exercise their rights to file a lawsuit in Consumer Court.
👉🏼 Conclusion
Although insurance companies have the right to consider claim payments based on policy conditions, applying pressure or offering compensation lower than legally prescribed rights may constitute unfair treatment toward consumers. Policyholders should therefore study policy conditions, preserve evidence at every step, and utilize OIC mechanisms or judicial processes to protect their rights. Being knowledgeable about the law is an essential tool to prevent consumers from being at a disadvantage in insurance contracts.
